Crit Care. 2026 Jul 6. doi: 10.1186/s13054-026-06172-w. Online ahead of print.
ABSTRACT
OBJECTIVE: To determine the effect of albumin-based fluid resuscitation on mortality in adults with septic shock.
DESIGN: Systematic review and dual frequentist-Bayesian meta-analysis of randomised clinical trials (RCTs), following PRISMA guidelines and preregistered protocol (CRD420261325998).
DATA SOURCES: PubMed, Embase, CENTRAL, and Scopus were searched from inception to February 2026.
METHODS: Eligible RCTs comparing albumin-based resuscitation strategies versus crystalloid-based resuscitation in adults with septic shock were included. The primary outcome was all-cause mortality at the longest available follow-up (up to 90 days). The analysis utilised random-effects models, subgroup analyses, and Bayesian methods.
RESULTS: Seven trials (n = 3273) were included. Three trials primarily recruited septic shock patients, while data from the remaining were derived from subgroups or extracted strata. At the longest available follow-up, albumin-based fluid resuscitation was associated with a statistically significant 10% reduction in the relative risk of all-cause mortality (RR 0.90, 95% CI 0.83-0.99; p = 0.02; I² = 0%). Bayesian analysis under the primary weakly informative prior yielded a posterior probability of mortality reduction of 94.7% (P[RR < 1.0]). Pre-specified subgroup analyses by albumin formulation, dosing strategy, and trial-level baseline serum albumin did not show evidence of effect modification.
CONCLUSION: In adults with septic shock, albumin-based resuscitation strategies are associated with a statistically significant reduction in mortality at the longest available follow-up, with a directionally concordant Bayesian estimate. A mortality benefit is therefore plausible, but the supporting evidence is indirect and imprecise (GRADE: low certainty). Adequately powered trials specifically addressing albumin fluid resuscitation in septic shock are warranted.
PMID:42410446 | DOI:10.1186/s13054-026-06172-w
